阿拉斯加原住民的肺炎球菌性心内膜炎。1978年至1990年基于人群的经验。

Pneumococcal endocarditis in Alaska natives. A population-based experience, 1978 through 1990.

作者信息

Finley J C, Davidson M, Parkinson A J, Sullivan R W

机构信息

Department of Medicine, Alaska Native Medical Center, Anchorage.

出版信息

Arch Intern Med. 1992 Aug;152(8):1641-5.

PMID:1497398

Abstract

BACKGROUND

Streptococcus pneumoniae is an uncommon cause of infective endocarditis (IE). We studied the presentation, microbiologic characteristics, and outcome of nine cases of S pneumoniae IE during a 12 1/2-year period in a population of 75,000 indigenous Alaska Natives (ANs), who have documented high rates of invasive pneumococcal disease.

METHODS

Fifty-six cases of IE occurred in ANs statewide during 1978 through 1990. Medical records of all nine confirmed cases of S pneumoniae IE were reviewed. Incidence rates for S pneumoniae IE and all IE were calculated.

RESULTS

Alaska Natives experience S pneumoniae IE as a fulminant illness, with acute aortic valve insufficiency (100%) frequently requiring emergent valve replacement, S pneumoniae meningitis (56%), and death (33%). No patient with S pneumoniae IE had known preexisting heart disease, and the most common underlying disease was alcoholism (56%). Pneumonia was diagnosed and embolic complications were suspected in 33%. All five S pneumoniae isolates examined were penicillin sensitive and were of serotypes included in the pneumococcal vaccine. Pneumococcal IE accounted for 15.8% of all IE diagnosed in ANs. Age- and sex-adjusted incidence rates for IE of all causes and S pneumoniae IE were 8.5 and 1.5 per 10(5) persons per year, respectively. During 1986 through 1988, 4.3% of AN adults diagnosed with S pneumoniae bacteremia developed S pneumoniae IE.

CONCLUSIONS

Pneumococcal endocarditis in all but one AN case required emergent valve replacement and had a 33% mortality. The annual incidence rate of S pneumoniae IE in this population was five to 37 times higher than contemporary rates elsewhere. Increased efforts to prevent pneumococcal disease in ANs appear warranted. Clinicians everywhere should anticipate the possible development of S pneumoniae IE in adult patients with pneumococcal sepsis, especially with meningitis, even with previous vaccination and prompt adequate antimicrobial therapy.

摘要

背景

肺炎链球菌是感染性心内膜炎（IE）的一种罕见病因。我们研究了在12年半的时间里，阿拉斯加75000名原住民（ANs）中9例肺炎链球菌性IE的临床表现、微生物学特征及转归情况，这些原住民侵袭性肺炎球菌病的发病率已得到记录。

方法

1978年至1990年期间，全州范围内的原住民中发生了56例IE。回顾了所有9例确诊的肺炎链球菌性IE的病历。计算了肺炎链球菌性IE和所有IE的发病率。

结果

阿拉斯加原住民的肺炎链球菌性IE表现为暴发性疾病，常伴有急性主动脉瓣关闭不全（100%），常需紧急进行瓣膜置换，还伴有肺炎链球菌性脑膜炎（56%）和死亡（33%）。没有肺炎链球菌性IE患者已知有既往心脏病史，最常见的基础疾病是酗酒（56%）。33%的患者诊断出肺炎，怀疑有栓塞并发症。检测的所有5株肺炎链球菌分离株对青霉素敏感，且属于肺炎球菌疫苗所含的血清型。肺炎球菌性IE占在阿拉斯加原住民中诊断出的所有IE的15.8%。所有病因导致的IE和肺炎链球菌性IE的年龄和性别调整发病率分别为每10万人年8.5例和1.5例。1986年至1988年期间，4.3%被诊断为肺炎链球菌菌血症的阿拉斯加原住民成年人发生了肺炎链球菌性IE。

结论

除1例阿拉斯加原住民病例外，所有肺炎球菌性心内膜炎病例均需紧急进行瓣膜置换，死亡率为33%。该人群中肺炎链球菌性IE的年发病率比其他地方的当代发病率高5至37倍。似乎有必要加大力度预防阿拉斯加原住民中的肺炎球菌病。各地临床医生应预计成年肺炎球菌败血症患者，尤其是伴有脑膜炎的患者，即使之前接种过疫苗并接受了及时充分的抗菌治疗，也可能发生肺炎链球菌性IE。